Research

Grants

Steven George, PhD, PT awarded funding from NCCIH at the NIH for study: "Improving Veteran Access To Integrated Management of Chronic Back Pain"

September 20, 2017

Durham, N.C. - We would like to congratulate Steven George, PhD, PT; along with co-PI Susan Nicole Hastings, MD; and co-investigators Chad Cook, PT, PhD, MBA, FAAOMPT; Corey Simon, DPT, PhD, FAAOMPT; and Adam Goode, PT, DPT, PhD; who were awarded a $7.9 million grant from the National Center for Complementary and Integrative Health (NCCIH) at the NIH for the study: "Improving Veteran Access To Integrated Management of Chronic Back Pain." The goal of this planning and demonstration project is to improve access to recommended nondrug therapies for low-back pain in the Department of VA Health Care System, and involves researchers from the DCRI, Department of Psychiatry and Behavioral Sciences, Durham VA Center for Health Services Research in Primary, and UNC Thurston Arthritis Research Center.

Benjamin A. Alman, MD, James Urbaniak Professor and Chair of the Department of Orthopaedic Surgery, went on to say, “We are incredibly proud of the work Dr. George is doing for our veterans, as well as the broader implications his work could have on the way we treat patients with chronic low-back pain.”

On Wednesday, September 20, 2017, the U.S. Department of Health and Human Services, the U.S. Department of Defense (DoD), and the U.S. Department of Veterans Affairs (VA) announced a multi-component research project focusing on nondrug approaches for pain management addressing the needs of service members and veterans. Twelve research projects (including Dr. Steven George's), totaling approximately $81 million over six years (pending available funds), will focus on developing, implementing, and testing cost-effective, large-scale, real-world research on nondrug approaches for pain management and related conditions in military and veteran health care delivery organizations. The National Institutes of Health (NIH) will be the lead HHS agency in this partnership.

“Finding solutions for chronic pain is of critical importance, especially for military personnel and veterans who are disproportionately affected,” said NIH Director Francis S. Collins, M.D., Ph.D. “Bringing the science to bear through these real-world research projects will accelerate our search for pain management strategies for all Americans, especially as we work to address the nation’s opioid crisis.”

The National Center for Complementary and Integrative Health (NCCIH), part of NIH, is contributing more than half of the total funding, and it is the lead for this multi-agency initiative called the NIH-DoD-VA Pain Management Collaboratory, which is modeled on the successful NIH Health Care Systems Research Collaboratory. This initiative also addresses the need to focus on “advancing better practices for pain management,” which is outlined in HHS’ 5-point strategy to combat the opioid crisis.

“NCCIH has made pain research a priority—especially in military and veteran populations. We first partnered with the National Institute on Drug Abuse and the VA in 2014 and are delighted to expand the partnership to include the DoD and additional HHS/NIH components,” said Dr. Josephine Briggs, director of NCCIH.

“We are so pleased to work alongside our federal partners to develop effective ways to treat pain in our service members and veterans that do not expose them to the risks of opioids,” said Rachel Ramoni, D.M.D., Sc.D., chief research and development officer for the VA. “This work reflects the VA’s commitment to reducing opioid overuse and expanding alternative pain management.”

Studies report nearly 45 percent of soldiers and 50 percent of veterans experience pain on a regular basis, and there is significant overlap among chronic pain, post-traumatic stress disorder (PTSD), and persistent post-concussive symptoms. Data from the National Health Interview Survey shows that American veterans experience a higher prevalence of pain and more severe pain than nonveterans. Although opioids are often prescribed to treat chronic pain, research has not shown them to be very effective, and there are many issues with long-term use. Thus, there is a need for nondrug approaches to complement current strategies for pain management and to reduce the need for, and hazards of, excessive reliance on opioids.

“Pain is the most common medical condition requiring treatment for military personnel. Current drug treatments have limited efficacy and are often associated with severe adverse events, significant cognitive and physiological side effects, and pose a significant risk of abuse, misuse, addiction, tolerance, and diversion. The proposals funded under this interagency partnership will provide a significant step forward in pain management in our wounded service members. We are pleased to be working with our interagency partners in driving changes to clinical practice that will impact the military, our veterans, and the Nation as a whole,” said Dr. George Ludwig, principal assistant for research and technology, U.S. Army Medical Research and Materiel Command (AMRMC).

Seven of the 12 projects, including Dr. Steven George's, have been awarded by HHS/NIH. The remaining five will be announced by the DoD and VA in the coming months.

HHS/NIH co-funders include the National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, National Institute of Neurological Disorders and Stroke, National Center for Medical Rehabilitation Research, which is part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Nursing Research, Office of Research on Women’s Health, and Office of Behavioral and Social Sciences Research. The DoD is funding this initiative through its Clinical and Rehabilitative Medicine Research Program and Military Operational Medicine Research Program, and the VA is providing funding through VA Office of Research and Development.

Durham, N.C. – A team of Duke researchers, led by Principal Investigator Adam Goode, PT, DPT, PhD, have received a 4-year, $2.4 million R01 grant from the National Institute of Arthritis, Musculoskeletal and Skin Diseases to conduct longitudinal analyses of the Johnston County Osteoarthritis Project - an ongoing population-based study investigating the incidence and progression of knee, hip and spine osteoarthritis - to determine if biochemical biomarkers and other risk factors predict the incidence and progression of intervertebral disc degeneration and facet joint osteoarthritis with and without low back symptoms. They will be working alongside the Thurston Arthritis Center and Department of Epidemiology at the University of North Carolina-Chapel Hill.

"We are very proud of Dr. Goode and his team for this important work. This research is directly applicable to healthcare and will not only strengthen and diversify our research portfolio, but also pave the way to improve the way we care for patients," said Benjamin A. Alman, MD, James Urbaniak Professor and Chair of the Department of Orthopaedic Surgery.

Lower back pain is a heterogeneous condition made up of underlying contributions from mechanical, inflammatory, or central pain influences. Currently, a primary way providers determine how to treat chronic lower back pain (cLBP) is through diagnostic clinical imaging.

Despite advances in clinical imaging, discordance between cLBP and spine degeneration is a major limiting factor in effectively delivering interventions. This leads to interventions that are inappropriate or unnecessary, with annual costs in the U.S exceeding $100 billion dollars. Furthermore, some of these interventions have serious complications that lead to infection or death.

The ability to better differentiate these causes would have a great impact on clinical treatment decisions. Dr. Goode and his team plan to use biochemical biomarkers related to mechanical cartilage degradation, inflammation, and pain, along with quantitative sensory testing, to better understand those individuals that may develop low back pain from intervertebral disc degeneration or facet joint osteoarthritis.

In their study, the Johnston County OA Project will be the derivation cohort and the Genetics of Generalized OA will be the validation cohort and will include over 4,000 participants. Stored bio specimens from both cohorts will be analyzed for newly discovered biomarkers of intervertebral disc degeneration in the Duke Molecular Physiology Lab with co-investigator, Virginia Byers Kraus, MD, PhD.

“I’m very excited to be able to continue this collaboration between Duke and UNC on spine osteoarthritis and work through some of the methodological and analytical challenges that go along with studying chronic disease incidence and progression. We hope that this work leads to a better understanding of the etiology of spine osteoarthritis so that treatment options can be targeted for prevention or slow progression,” said Dr. Goode.

Co-investigators on the study also include Steven Z. George, PT, PhD, and Jun Chen, PhD.